H. pylori

Nausea, diarrhea, abdominal cramps, H. pylori with duodenal ulcer Ulcerative colitis... 

The proton pump inhibitors are particularly important in the treatment of Helicobacter pylori in patients with active duodenal ulcers. Helicobacter pylori (H. pylori) has been implicated as a causative organism in a type of chronic gastritis and in a large number of cases of peptic and duodenal ulcers. 

TABLE 48-1 Agents Used to Treat H. Pylori in Patients With Duodenal Ulcers... 

DRUG USE FOR ERADICATION OF H. PYLORI IN PATIENTS WITH DUODENAL ULCER DOSAGE RANGE... 

Bismudi subsalicylate is used in combination witii otiier dru > to treat gastric and duodenal ulcers caused by H. pylori bacteria Mesalamine is used in the treatment of chronic inflammatoiy bowel disease Misoprostol is used to prevent gastric ulcers in those taking aspirin or nonsteroidal anti-inflammatory dragp in high doses for a prolonged time Olsalazine is used in the treatment of ulcerative colitis in those allergic to sulfasalazine. Sulfasalazine is used in the treatment of Crohn s disease and ulcerative colitis. Sucralfate is used in the treatment of duodenal ulcer. 

Systemic treatment of erythrosis finds its rationale in the association of rosacea with H. Pylori infection. The following scheme has heen suggested clarithromycin 250 mg twice daily + metronidazole 400 mg twice daily clarithrom-... 

Gl, gastrointestinal H. pylori, Helicobacter pylori NSAID, non-steroidal anti-inflammatory drug SRMD, stress-related mucosal damage. 

The treatment selected for PUD depends on the following factors (1) the etiology of the ulcer (2) whether the ulcer is new or recurrent and (3) the presence of any ulcer-related complications. Figure 15-2 contains an algorithm for the evaluation and treatment of a patient with signs and symptoms suggestive of an H. pylori-associated or NSAID-induced ulcer. 

Demirev, P. A. Lin, J. S. Pineda, F. J. Fenselau, C. Bioinformatics and mass spectrometry for microorganism identification Proteome-wide post-translational modifications and database search algorithms for characterization of intact H. Pylori. Anal. Chem. 2001, 73, 4566 573. 

Ogasrtro (Lansoprazole) Duodenal ulcer Gastro-oesophageal reflux Helicobacter infections 2.3 0.8 1994 - UK 1995 - US Once daily, except when used as part of combination therapy for H. pylori and for hypersectetory conditions. Twice-daily when dose >120 mg. 

Given the role of H. pylori infection in gastric cancer and duodenal ulcer disease, one must note that certain interleukin-1 gene cluster polymorphisms (suspected of increasing production of interleukin-1-/1) are associated with a predisposition to hypochlorhydria and gastric cancer [52]. One of these host DNA polymorphisms involves a TATA box. 

Etiology H. pylori-induced atrophy of gastric mucosa, drug-induced etc. Failure of small bowel motility or intestinal anatomical abnormality... 

Fig. 2. Median gastric pH is elevated about 2 log by 20 mg of omeprazole in H. pylori-negative healthy subjects, and by 4 log in H. pylo-n -positive ones [based on data from 42], Hp = H. pylori, PPI = proton pump inhibitor. 

When the gastritis induced by H. pylori is confined to the antrum, the increase of gastrin and the reduction of somatostatin released by the G and D cells in the antrum, respectively, will increase the drive for acid secretion from the preserved oxyntic mucosa [45]. This increased... 

In another subpopulation, the Helicobacter gastritis extends into the corpus resulting in atrophy of the oxyntic mucosa and reduced acid secretion. It is not yet clear to which extent these manifestations reflect different stages or different courses of Helicobacter-induced gastritis [41, 45], H. pylori thus emerges as the main cause of acquired gastric hypochlorhydria [46-48],... 

GNB = Gram-negative bacilli PPI = proton pump inhibitor Hp = H. pylori. a Patients with peptic ulcer disease and reflux esophagitis. b Early stage of atrophic corpus gastritis of limited extension (less common). 

The prevalence of Gram-negative bacilli colonization depends on the type of surgery (see text). d Atrophic corpus gastritis (prevalent in the elderly due to the high prevalence and duration of H. pylori colonization in this age cohort). 

Selective failure of the gastric acid barrier, as seen in otherwise healthy individuals on proton pump inhibitors or with H. pylori-induced corpus gastritis, results in gastric colonization of swallowed oropharyngeal bacteria. In otherwise healthy subjects this will be mainly Gram-positive bacteria belonging to the URT flora and strict anaerobic bacteria of oral origin. 

H. pylori is now recognized as the main cause of selective gastric hypochlorhydria, which today is highly prevalent (more than 50%) in the normal elderly population of western countries and predominant in developing countries with prevalence often exceeding 90%. The in-... 

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